Our faces serve critical physical, emotional, social and psychological functions and facial paralysis may adversely affect all these functions. Important physical functions include the ability to blink for eye protection, lower eyelid support to permit eyelid closure, nasal support to maintain nostril opening, and muscle support in the upper and lower lips to prevent mouth drooping and drooling. Furthermore, a unique function of the face is its ability to express socially appropriate emotions and animations which include smiling and natural movement with speech. Individuals with facial paralysis hence experience significant functional and aesthetic disruption that adversely affects their physical, social and emotional well-being. Reconstruction of facial paralyis often brings great satisfaction to affected individuals.
The facial nerve is an important and anatomically complex nerve that controls the majority of the animations of the face. It consists of an upper and lower trunk, which divide into five main branches: the temporal, zygomatic, buccal, marginal mandibular and cervical. There are interconnections between some of these branches and there is also significant variation between individuals.
The extent and degree of facial nerve paralysis depends on the affected branches or trunks.
There are a multitude of causes of facial nerve paralysis. These include:
Reconstruction of the paralyzed face is extremely important in the functional and psychological rehabilitation of the individual. The type of reconstruction performed is dependent on the cause of the facial paralysis, the duration of paralysis, the individual’s age and wishes. Successful reconstruction restores quality of life significantly and improves social and societal reintegration. Facial reanimation requires an individualized approach, accurate assessment, precise technical execution and an experienced practitioner.
Eye protection measures are required to preserve the lubrication of the eye and prevent formation of corneal ulcers due to desiccation (dryness), which may lead to visual loss. This may include nighttime eyelid taping, use of lubricant gels and moisture chambers. Severe cases may require minor surgery to suture the eyelids partially together.
Acute facial nerve paralysis caused by tumor resection or transection of the nerve is ideally repaired immediately in the operating room using microsurgical technique. This involves joining the ends of the cut nerve using ultra-fine sutures that are thinner than a strand of hair. In cases where there is a loss of a length of the nerve, nerve grafts may be harvested from the inner forearm or the calf to bridge the nerve defect.
Reconstruction of chronic facial paralysis is dependent on the individual’s wishes for static and/or dynamic symmetry. Procedures that are often used to restore static symmetry include:
Procedures that are often used to restore dynamic symmetry and movement of the face include:
The head and neck region is a complex and intricate one that serves critical physical, emotional, social and psychological functions. Reconstruction of this region requires restoration of both function and aesthetic and necessitates experienced and skilled practitioners. Dr Yeo has a keen clinical interest in this area and has been at the forefront of delivery of this care. He received postgraduate training as an international fellow under the illustrious Professor Hung-Chi Chen, one of the global leaders in advanced reconstructive microsurgery in the head and neck. Dr Chen is also one of the global authorities in intestinal flap reconstruction of the head and neck region and Dr Yeo is pleased to have the unique distinction of performing intestinal flap reconstruction of the pharynx in Singapore.